Laser Assisted Uvulopalatoplasty (LAUP)
DESCRIPTION
Laser-assisted uvulopalatoplasty (LAUP) is an outpatient procedure proposed as a treatment for snoring with or without associated obstructive sleep apnea. The procedure sequentially reshapes superficial palatal tissue using a carbon dioxide laser. LAUP differs from standard uvulopalatopharyngoplasty (UPPP) since only part of the uvula and associated soft-palate tissues are reshaped. LAUP does not remove or alter tonsils or lateral pharyngeal wall tissue. LAUP is performed in 3 - 7 sessions at 3 - 4-week intervals. One purported advantage of LAUP is that the amount of tissue ablated can be titrated so treatment can be discontinued once snoring is eliminated.
LAUP cannot be considered an equivalent procedure to UPPP. LAUP also differs from radiofrequency ablation of the soft palate although the concept is similar.
POLICY
Laser-assisted uvulopalatoplasty (LAUP) for the treatment of obstructive sleep apnea syndrome is considered investigational.
Laser-assisted uvulopalatoplasty (LAUP) for the treatment of socially disruptive snoring alone is considered not medically necessary.
IMPORTANT REMINDERS
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ADDITIONAL INFORMATION
Minimally invasive surgical procedures such as LAUP have limited efficacy in individuals with mild-to-moderate OSA and have not been shown to improve excessive daytime sleepiness in adults. Additional studies are needed.
SOURCES
American Academy of Otolaryngology – Head and Neck Surgery. (2021). Position statement: surgical management of obstructive sleep apnea. Retrieved March 15, 2024 from http://www.entnet.org/content/surgical-management-obstructive-sleep-apnea.
American Academy of Sleep Medicine. (2021). Referral of adults with obstructive sleep apnea for surgical consultation: an American academy of sleep medicine clinical practice guideline. Retrieved March 15, 2024 from https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.9592.
BlueCross BlueShield Association. Evidence Positioning System. (7:2023). Surgical treatment of snoring and obstructive sleep apnea syndrome. (7.01.101). Retrieved March 15, 2024 from www.bcbsaoca.com/eps/. (30 articles and/or guidelines reviewed)
Camacho, M., Nesbitt, B., Lambert, E., Song, S., Chang, E., Liu, S., et al. (2017). Laser-assisted uvulopalatoplasty for obstructive sleep apnea: a systematic review and meta-analysis. Sleep, 40 (3), 1-8. (Level 1 evidence)
CMS.gov: Centers for Medicare & Medicaid Services. Wisconsin Physicians Service Insurance Corporation. (2023, July). Surgical treatment of obstructive sleep apnea (OSA). (LCD ID L34526). Retrieved March 15, 2024 from https://www.cms.gov.
Wischhusen, J., Qureshi, U., & Camacho, M. (2019). Laser-assisted uvulopalatoplasty (LAUP) complications and side effects: a systematic review. Nature and Science of Sleep, 11, 59–67. (Level 1 evidence)
ORIGINAL EFFECTIVE DATE: 3/1985
MOST RECENT REVIEW DATE: 4/11/2024
ID_BT
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